Alcohol and Drug Misuse

If you are concerned that you are drinking too much alcohol use this handy assessment tool to see if this is the case: Alcohol self assessment

For information and support to help cut down your drinking visit One you drinking

If you feel that you are unable to control your drinking and need further help or are abusing drugs please contact our Local substance misuse team or make an appointment with your GP.

Counselling

We work very closely with our Talking Therapies counselling team. If you feel that you need a referral for counselling or Cognitive Behaviour Therapy please make an appointment with your GP.

Patients can now self-refer. This service is open from 1000-1600, call 01625 469 955.

For more information about the counselling services and the help that they can offer -Patient information

Dietary Advice

Our nursing team are very skilled at giving dietary advice and helping and supporting patients to lose weight. We also run a healthier living programme to support patients with a high BMI to lose weight.

Asthma

Asthma is a very common condition which can be managed by changes to lifestyle and also medication.

If you have asthma then you will be invited for an annual review with our specialist practice nurse. This is a 15 minute appointment and will look to assess your asthma and look at ways to further improve control.

If you feel that your asthma is not well controlled then you can complete this simple test to check please click on check your asthma risk .

COPD (Chronic Obstructive Pulmonary Disease)

COPD is the name for a collection of lung diseases, including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have trouble breathing in and out, due to long-term damage to the lungs, usually because of smoking.

There is no cure for COPD, but there are many things you can do to relieve symptoms and keep the disease from getting worse. If you smoke, now is the time to quit; this is the best way to slow lung damage.

Treatments include:

inhalers and medications– to help make breathing easier

pulmonary rehabilitation– a specialised programme of exercise and education

surgery – although this is only an option for a very small number of people

At Park Lane Surgery we have a specialist Practice Nurse, Miriam Wilson and GP, Dr Ann Holden who help patients with COPD manage their condition. These patients are invited in to the surgery during their birth month for an annual review where their condition will be discussed with them and then a care plan will be made in conjuction with the patient.

If you think that you may have COPD please click on the link below and then book into to see a GP to discuss your concerns further.

CHD (Coronary Heart Disease) and Hypertension (High Blood Pressure)

We have annual appointments for all our patients suffering from Coronary Heart Disease and/or hypertension with our practice nurses who monitor and manage these conditions.

For more information on hypertension and how to manage your cholesterol please see leaflets on the following link: Patient Information leaflet

Diabetes

We have a specialist GP and two specialist nurses who help manage our diabetic patients. They will review patients on an annual basis not only to, make sure their diabetes is under control but also look at ways to improve this control through better self-management of their lifestyle.

We are supported by a specialist community diabetes service which includes Diabetic Specialist Nurses and consultants to help manage more complex patients and those on insulin or being initiated on insulin.

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Minor Surgery Clinic

Two of our doctors perform minor surgery approximately once a month. Within this clinic small lesions or lumps which are causing patients problems are removed under local anaesthetic. All minor surgery we do must meet specific NHS criteria. We do not carry out procedures for cosmetic reasons.

We are able to remove:

Skin lumps - Lipomas

Cysts

Moles

Skin Tags - (too large for cryotherapy)

Warts - seborrheic keratoses

Toe nails - ingrown

If you are concerned about any of these or wish to have them removed then please make a routine appointment with one of the Doctors to discuss your requirements and options.

Cryotherapy

Skin cryosurgery, or cryotherapy, is a procedure to treat your skin lesion by freezing it. A skin lesion is a spot or growth on your skin. Skin cryotherapy is done using a cold substance, liquid nitrogen. It works by cooling the tissues until ice balls form. The cold kills the lesions' skin cells, without hurting healthy tissue that is nearby. As the skin thaws the cells which have been frozen are damaged and new healthy cells will grow to replace them.

Why might I use this service?

To remove benign (non-cancer) lesions, such as angiomas, small skin tags, sun damaged areas, verrucas and warts. Ask your care giver for more information on wart removal using cryosurgery.

The treatment may be sufficient to loosen it but you may need to lift it off to make sure that it does not become re attached as the skin repairs itself.

Joint Injections

What is a joint injection and why have I been given one?

When your joints are swollen and tender, we often put a needle into your joints to draw out fluid and inject steroid into them. The steroid reduces the swelling and pain you have, so you can use your joint again. Joint injections are done for people with rheumatoid arthritis, osteoarthritis and many other conditions. Sometimes we inject into the tissues around joints as well because this can help with conditions such as tennis elbow.

GP Fees for Non NHS Services

Non-NHS work

Some services are not covered by the NHS and we will therefore charge a fee for completion of this work. The NHS medical care of our patients takes priority during our working day so any private letters or forms can take up to 3 weeks to complete and return to you. We cannot guarantee they will be completed earlier.

Why do GPs sometimes charge fees?

It is important to understand that many GPs are not employed by the NHS.

They are self-employed and they have to cover their costs - staff, buildings etc - in the same way as any small business. The NHS covers these costs for NHS work but for non-NHS work, the fees charged by GPs contribute towards these costs.

The government's contract with GPs covers medical services to NHS patients including the provision of ongoing medical treatment. In recent years however more and more organisations have been involving doctors in a whole range of non-medical work.

Sometimes the only reason that GPs are asked is because they are in a postion of trust in the community or because an insurance company or employer wants to ensure that information provided to them is true and accurate.

Do GPs have to do non-NHS work for their patients?

With certain limited exceptions for example a GP confirming that one of their patients is not fit for jury service, GPs do not have to carry out non-NHS work on behalf of their patients.

Whilst GPs will always attempt to assist their patients with the completion of forms for example for insurance purposes, they are not required to do such non-NHS work.

Why does it sometimes take my GP a long time to complete my form?

Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients.

Most GPs have a very heavy workload and paperwork takes up an increasing amount of their time, so many GPs find they have to complete this work outside of and in addition to their normal hours.

I only need the doctor's signature - what is the problem?

When a doctor signs a certificate or completes a report it is a condition of remaining on the Medical Register that they only sign what they know to be true.

In order to complete even the simplest of forms therefore, the doctor might have to check the patient's entire medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors' regulatory body) or even the police.

The Fees for non-NHS medical services are based on the British Medical Association (BMA) suggested scales and our reception staff will be happy to advise you about them along with appointment availability.

Child hood Immunisations

Our child immunisation clinics are run by our practice nurses and take place on a Wednesday morning for full details of the immunisation schedule and for more information: Vaccination schedule . Your child will be sent a letter by Public Health advising you of this schedule and the actions you need to take.

Contraception

We offer a number of services regarding contraception including ‘pill checks’ with our nursing staff who can also offer advice on a variety of different contraceptive measures. Our nursing staff perform depo injections and contraceptive implant insertion can be arranged with our doctors.

Wound Care

Our Practice Nurses and Assistant Practitioner offer appointments for wound care after you have had a procedure. This ranges from simple removal of sutures to regular management of wound dressing and ulcer dressing management. Please contact reception to book into these appointments. A call back may be required by one of the nursing team to establish your exact requirements.

Ear Syringing

Why might you require your ears syringing?

If there is a build-up of wax in your ear(s) please read the following self-help guide as you may not need an appointment.

What is ear wax?

Ear wax is normal and is produced to form a protective coating over the skin in the ear canal. Ears are normally self-cleaning – the movement of your jaw whilst eating and talking helps to move the wax along the canal where it will usually fall out naturally without you noticing.

Why is my ear blocked with wax?

The amount of ear wax produced varies from person to person; some people produce excessive amounts which can lead to a blockage in the ear canal.

You are more likely to develop a blockage of wax in the canal if you:

use cotton ear buds to clean the ear as this pushes the wax deeper into the canal

wear a hearing aid, ear plugs or use in-ear speakers for i-pods or similar - as these can all interfere with the natural process of wax expulsion

have abnormally narrow ear canals

have a particularly hairy ear canal

are elderly – because the ear wax you produce is drier and harder

have a dry skin problem such as eczema or psoriasis

Advice to help you manage and prevent ear wax blockage

Ear wax only becomes a problem if it causes deafness, discomfort or if your Health professional requires a clear view or your ear drum.

If you experience any of the following, you should seek advice from your GP or Nurse Practitioner at Park Lane Surgery:

pain

discharge or bleeding from the ear

sudden deafness or buzzing

foreign bodies in the ear

dizziness

If you are not experiencing any of the above, we recommend that you manage the blockage as below:

Olive Oil Drops– The following needs to be done 2 3 times daily for 14 days.

Lie on your side with the affected ear uppermost

Pull the outer ear gently backwards and upwards to straighten the ear canal

Put 2-3 drops of olive oil into the affected ear(s) and gently massage just in front of the ear

Stay laying on your side to allow the wax to soak in for around 10 mins

Afterwards, wipe away any excess oil but do not plug your ear with cotton wool as this simply absorbs the oil

Your hearing problem may initially worsen after first starting to use the olive oil drops; this is why we advise you to concentrate on treating one ear at a time if both ears are blocked with wax.

In most cases, after 14 days, the wax will have softened sufficiently to encourage the wax to come out without further intervention. However, if you feel your hearing is still impaired, please make an appointment with the practice nurse for further advice and management.

Ear Syringing– is only usually considered if the above recommendations have proved to be unsuccessful. Ear wax needs to be softened as above for 5-7 days before attempting to syringe. Although the risks are low and our nurses are specially trained to perform this procedure, there is still a small chance (thought to be around 1 in 1000) of complications occurring - such as a perforated ear drum, middle ear infection, external canal infection or causing ringing in the ear (tinnitus).

If your ears are regularly becoming blocked with wax, after clearing the blockage we will usually suggest you use olive oil drops as above around once per week to keep the wax soft and encourage the natural process of wax expulsion.

In order to organise ear syringing you will need to make a routine appointment with our practice nurse. Prior to this appointment please use olive oil or eardrops to your ear to soften the wax for 10 days in order to make the procedure as pain free and successful as possible.

Travel Vaccinations

If you think you may require vaccinations relating to foreign travel you need to make a travel appointment with the practice nurse to discuss your travel arrangements. This will include which countries and areas within countries that you are visiting to determine what vaccinations are required.

There is further information about countries and vaccinations required on the links below

It is important to make this initial appointment as early as possible - If possible book an appointment 4 weeks ahead of the date you wish to travel and complete the travel questionnaire below.

We will review questionnaire and ONLY contact you if you DON'T need the appointment as you may be sufficiently covered for all vaccinations that the country specifies.

If you are travelling sooner than 4 weeks still do all of the above however you may not have enough time to seek private vaccinations if required.

Some travel vaccines are ordered on a private prescription and these incur a charge over and above the normal prescription charge. This is because not all travel vaccinations are included in the services provided by the NHS.

Travel Health Questionnaire

To help us offer the appropriate advice, please fill out the online form before coming to see one of our nurses.

Abdominal Aortic Aneurysm (AAA) Screening

This is a way of detecting a major swelling (aneurysm) of the aorta – the main blood vessel that travels from the heart down through the body. If this blood vessel is enlarged there are no symptoms but can burst which is most often fatal.

As it is more much more common in men, men aged 65 are invited for an ultrasound scan of your stomach.

Bowel Screening

If bowel cancer is detected at any early age it is easier to treat and survival rates are higher.

There are currently 2 types of screening programmes

All men and women aged 60-74are invited to carry out a faecal occult blood (FOB) test. Every two years, they're sent a home test kit, which is used to collect a stool sample.

An additionalone-off test called bowel scope screening is gradually being introduced in England. This is offered to men and women at the age of 55. It involves a doctor or nurse using a thin, flexible instrument to look inside the lower part of the bowel.

If you are outside of these age ranges you can opt in to the screening programme.

Cervical Cytology

The cervical screening programme begins when a women turns 25. You will be called every 3 years until you turn 50 then every 5 years until the age of 65. Cervical smears are performed by our practice nurses. You will receive a letter asking you to make an appointment when your cervical screening is due. Once you have received this letter please make an appointment with one of our Practice Nurses.

NHS Health Check

We run free 5 yearly NHS health checks for patients aged between 40 and 74. This is designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes and dementia.

We send letters to patients inviting them for a health check which consists of a blood tests and a consultation with our nurse. A further follow up to discuss results and look at ways to lower risk and improve overall health.

Prostate Cancer

There is not a screening test for prostate cancer currently. A blood test called PSA (Prostate Specific Antigen) can sometimes detect early signs of prostate enlargement one of the first signs of prostate cancer. Unfortunately this test is affected by a number of different factors and can sometime not be raised in a man with prostate cancer.

This means the PSA testing is not routinely offered to men due to it’s limitations and potential harmful consequences.

If this is a test you would like to consider we recommend discussing this with your doctor.

The sinuses are small hollow spaces in the bones surrounding the nose. After a cold the lining of these can become inflamed and infected and produce large amounts of mucus. This condition is known as sinusitis.

Sinusitis can cause the following symptoms:

Pain over the affected area. This is often felt as a throbbing pain over the cheeks, eyes or forehead.

The nose may be runny with lots of yellow/green mucus. Sometimes the sinuses block with very thick mucus which can be very painful.

Some patients may develop a high temperature (fever).

How long will my sinusitis last?It often lasts up to two and a half weeks.

How can sinusitis be treated? - All of which can be purchased from your pharmacist

There are several things that you can do at home to relieve the symptoms of sinusitis:

Painkillers such as ibuprofen or paracetamol may be useful in relieving the discomfort.

Intra-nasal corticosteroids have been shown to be more effective than placebo or antibiotics

Intra-nasal decongestants can help relieve the symptoms of a blocked nose. They should be used for no more than 5-7 days because they may make your symptoms worse after this time. Your pharmacist can advise you which product may be suitable. Oral decongestants are generally not recommended.

Saline nasal drops may relieve congestion

Although clinical trials have failed to show any symptomatic improvement from steaming you may find that this does help to alleviate your symptoms

In very severe or prolonged cases your doctor may prescribe a short course of antibiotics. Antibiotics are not generally recommended for symptoms of less than 7-10 days.

Why you should only take antibiotics when they are needed

98 % of cases of sinusitis are caused by a virus so antibiotics are ineffective and are therefore not recommended

to avoid antibiotic resistance

to avoid the side effects of antibiotics such thrush and diarrhoea

When should I speak to my doctor?

Most cases of sinusitis will clear up without treatment. If you suffer any of the following symptoms, contact your doctor.

If the sinusitis does not improve after 7-10 days of over the counter treatment.

If your face starts to swell, particularly around the eyes.

If you develop a persistent high temperature.

Severe, persistent worsening pain over one side of your face.

Conjunctivitis

What causes conjunctivitis?

Most cases of infective conjunctivitis are caused by common germs (bacteria and viruses). These are often the same ones that cause coughs and colds. Conjunctivitis commonly develops when you have a cold or cough, although sometimes it occurs alone. In the vast majority of cases, infective conjunctivitis is not serious. It clears within a week or so without leaving any permanent damage to the eye.

What are the symptoms of conjunctivitis?

Conjunctivitis usually spreads to both eyes.

The eyes may feel gritty and may water more than usual.

Some mild soreness may develop, but the condition is not usually very painful.

The eyelids may become swollen. They are often stuck together with gluey material (discharge) after a sleep.

Vision is not normally affected. You may get some blurring of vision due to discharge at the front of the eye. However, this clears with blinking.

The whites of the eyes can look inflamed, and red or pink.

What is the treatment for conjunctivitis?

The common option for mild or moderate cases is no treatment. Your tears contain chemicals that fight off germs (bacteria). Without treatment, most cases of infective conjunctivitis clear on their own within 1-2 weeks. Often they clear within 2-5 days. However there are some other options which may help to ease the symptoms:

Bathing the eyes - regularly using cool clean water and cotton wool, this will help to sooth the eyes and clean away any sticky discharge.

Lubricant eye drops - these may reduce eye discomfort and are available over the counter. Your pharmacist will be able to advise which ones they stock.

Antibiotic eye drops - such as Chloramphenicol, can also be purchased over the counter after discussion with the pharmacist. However these are usually only necessary in more severe cases, or those not clearing on their own.

To prevent passing infection on to others avoid sharing face towels or pillowcases

Guidance from The Health Protection Agency states thatit is not necessary to exclude a child from school or care - unless there is an outbreak of several cases.

Coughs

Cough is part of the body’s defence mechanism and helps to prevent the lungs becoming damaged from the dust and germs that we can breathe in. A cough may be either chesty with the production of mucus or phlegm or dry and irritating with little or no mucus.

Chesty Cough is often associated with colds or flu but may take several weeks to go completely. Mucus (or phlegm) is produced in the upper airways to act as a barrier to trap dust and germs that is then cleared away as we cough.

Dry Cough can also last for several weeks and can occur after other cold symptoms have largely cleared up. The cough may be tickly and irritating but produces little or no mucus.

How can I help my cough?

Drink plenty of fluids to prevent dehydration

Take paracetamol if you have a temperature or aches and pains but do not take more than the dose recommended on the packet. Paracetamol is also available as a liquid medicine for children (e.g. Calpol).

Some people find cough medicines, lozenges or sweets are soothing. Your pharmacist can recommend a suitable product.

Adding a few menthol crystals or some Karvol to a bowl of warm water and inhaling the fumes can help to loosen thick mucus and make it easier to cough up.

Duration of Illness – usually symptoms improve after 2-3 days but it can take up to 3 weeks for the cough to go completely

It is necessary to contact your doctor if:

You begin to cough up blood

You become unusually breathless

The cough does not improve or gets worse after 2-3 weeks

If you develop any other new or worrying symptoms

If you have another illness (such as asthma, chronic obstructive pulmonary disease, diabetes, or congestive heart failure)

Why We Are Trying To Reduce The Use Of Antibiotics:

Bacteria can adapt and find ways to survive the effects of an antibiotic. They become ‘antibiotic resistant’ so the antibiotic no longer works. The more you use an antibiotic, the more bacteria become resistant to it.

Antibiotic resistant bacteria don’t just infect you; they can spread to other people in close contact with you.

Antibiotics can upset the natural balance of bacteria in your body. This allows other more harmful bacteria to increase. This may result in diarrhoea and thrush.

Some antibiotics can cause allergic reactions such as rashes, being sick if you drink alcohol and reactions to sunlight.

Sore Throat

Sore throats and tonsillitis are usually caused by a virus and may be accompanied with a high temperature, pain on swallowing and hoarseness. Most cases will clear up without treatment within 7 days.

What causes sore throats?

Sore throats commonly occur with or following a cold and are seen more frequently during the winter months, particularly in children and young adults. Most cases are caused by a virus that makes the throat and tonsils sore, red and inflamed.

Will antibiotics help?

Antibiotics have no effect on viruses so taking them will usually not help a sore throat. Using an antibiotic when one is not required is not recommended as it can make them less effective against more serious infections. Antibiotic side effects can make you feel worse it can also lead to diarrhoea and thrush.

How can I help my sore throat?

Drink plenty of clear fluids (e.g. fruit squash). This will help to prevent dehydration and reduce a high temperature (fever). Avoid hot drinks.

Paracetamol or Ibuprofen can relieve the pain and soreness but it is important not to exceed the dose on the packet.

Some patients get relief from gargles and sprays available from the pharmacy. Your pharmacist will be able to advise you which products are suitable.

Adults only may get relief from gargling with soluble aspirin this is not suitable for anyone under the age of 16.

It is necessary to contact your doctor if:

You are having difficulty swallowing, breathing or are drooling

You have a persistent high temperature (>38OC)

You develop an unusual rash

There are white spots on the tonsils

There is swelling in the neck, armpit or groin area

If the sore throat does not improve or gets worse after one week

You have severe and worsening pain

Ear Infections

An infection of the outer ear is called otitis externa and an infection of the middle ear is called otitis media. The outer ear includes all the parts of the ear outside the body and up to your eardrum. The middle ear includes all the parts between the eardrum and the hearing nerve.

What are the signs of a Middle Ear Infection?

Ear Ache

Temperatures/Fevers

Discharge from the ear

Loss of hearing from the ear

How Long Will My Infection Last?

Most infections last 2-4 days

How Can I Help My Ear Infection?

Simple painkillers (such as paracetamol and ibuprofen) will manage the pain and discomfort of an ear infection

Many cases are viral and 2/3rds of cases will settle within 24 hours.

In 14 out of 15 cases of ear infections get better as quickly without antibiotic as they would have done with antibiotics

It is necessary to see your doctor if:

Persistent high temperature (above 38°C)

Children under the age of 2 with symptoms effecting both ears

Discharge from the ear

If you have grommets in the ear

If you notice any swelling, redness or pain to the bone behind the ear

Why We Are Trying To Reduce The Use Of Antibiotics:

Bacteria can adapt and find ways to survive the effects of an antibiotic. They become ‘antibiotic resistant’ so the antibiotic no longer works. The more you use an antibiotic, the more bacteria become resistant to it.

Antibiotic resistant bacteria don’t just infect you; they can spread to other people in close contact with you.

Antibiotics can upset the natural balance of bacteria in your body. This allows other more harmful bacteria to increase. This may result in diarrhoea and thrush.

Some antibiotics can cause allergic reactions such as rashes, being sick if you drink alcohol and reactions to sunlight.

Macclesfield Health Visitors

If you need to speak to a health visitor they are available from 0930-1630 Monday -Friday on: 0300 123 0755

Alternatively you can visit them at one of the 'Drop in Advice Clinics' as below: